Mothering alone: cross-national comparisons of later-life disability and health among women who were single mothers.

Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA Departments of Social and Behavioral Sciences; Epidemiology; and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

2

School of Public Policy and Management, Tsinghua University, Beijing, China.

3

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.

4

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA London School of Economics and Political Science, LSE Health, London, UK.

5

Munich Center for the Economics of Aging at the Max Planck Institute for Social Law and Social Policy, Munich, Germany.

6

Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA.

Abstract

BACKGROUND:

Single motherhood is associated with poorer health, but whether this association varies between countries is not known. We examine associations between single motherhood and poor later-life health in the USA, England and 13 European countries.

METHODS:

Data came from 25 125 women aged 50+ who participated in the US Health and Retirement Study, the English Longitudinal Study of Ageing and Survey of Health, Ageing and Retirement in Europe. We tested whether single motherhood at ages 16-49 was associated with increased risk of limitations with activities of daily living (ADL), instrumental ADL and fair/poor self-rated health in later life.

RESULTS:

33% of American mothers had experienced single motherhood before age 50, versus 22% in England, 38% in Scandinavia, 22% in Western Europe and 10% in Southern Europe. Single mothers had higher risk of poorer health and disability in later life than married mothers, but associations varied between countries. For example, risk ratios for ADL limitations were 1.51 (95% CI 1.29 to 1.98) in England, 1.50 (1.10 to 2.05) in Scandinavia and 1.27 (1.17 to 1.40) in the USA, versus 1.09 (0.80 to 1.47) in Western Europe, 1.13 (0.80 to 1.60) in Southern Europe and 0.93 (0.66 to 1.31) in Eastern Europe. Women who were single mothers before age 20, for 8+ years, or resulting from divorce or non-marital childbearing, were at particular risk.

CONCLUSIONS:

Single motherhood during early-adulthood or mid-adulthood is associated with poorer health in later life. Risks were greatest in England, the USA and Scandinavia. Selection and causation mechanisms might both explain between-country variation.

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Single motherhood and adjusted relative risks of disability and SRH among mothers aged 50+, by quartiles of single motherhood durationNotes:“*” indicates p value < 0.05.Data from ELSA, SHARE, and HRS are pooled in this analysis. Adjusted relative risks were obtained from modified Poisson regressions, with robust variance clustered at individual level. Key independent variables include binary indicators on quartiles of single motherhood duration: 1–3 years, 4–7 years, 8–13 years, 14+ years. The comparison group is mothers who never had single motherhood experience before age 50. Additional covariates include age, age squared, education, number of children, current marital status, time of interview, and country-fixed effects. Data are weighted by sampling weights.

Single motherhood and adjusted Relative risks of disability and SRH among mothers aged 50+, by causes or ages of single motherhood, conditional on single motherhood durationNotes:“*” indicates p value < 0.05.Adjusted relative risks (RRs) of single motherhood by causes and ages of the single motherhood experience were estimated by running two sets of Poisson regressions: one has causes and quartiles of single motherhood duration as key independent variables, while the other has ages and quartiles of single motherhood duration as key independent variables. RRs reported in Figure 2-a and 2-b reflect the RRs of single mothers assuming a single motherhood duration of 8–13 years. The comparison group is mothers who never had single motherhood experience before age 50. Additional covariates include age, age squared, education, number of children, current marital status, time of interview, and country-fixed effects.